Comprehensive PN VATI Medical Surgical
Study Guide 2025 Edition | Detailed Notes,
Key Concepts, Case Studies,
Pharmacology, Pathophysiology,
Nursing Procedures, Exam Preparation
Tips, Practice Questions, and Verified
Answers for Nursing Students and
Professionals
Question 1: A practical nurse is caring for a client with heart failure who is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate notification of the registered nurse?
A. Blood pressure 110/70 mm Hg
B. Urine output 30 mL/hr
C. Potassium level 3.2 mEq/L
D. Weight loss of 1 kg in 24 hours
CORRECT ANSWER: C. Potassium level 3.2 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes potassium excretion, placing the client at high
risk for hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L) and can
cause life-threatening cardiac dysrhythmias, muscle weakness, and fatigue. This finding requires
immediate notification for potential potassium replacement. Options A, B, and D represent expected or
stable findings in a client receiving diuretic therapy for heart failure.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The practical nurse notes the client is becoming increasingly confused and drowsy.
Which action should the nurse take first?
A. Increase oxygen flow to 4 L/min
B. Notify the registered nurse immediately
C. Check the client's oxygen saturation level
D. Encourage the client to cough and deep breathe
CORRECT ANSWER: C. Check the client's oxygen saturation level
RATIONALE: In clients with COPD, excessive oxygen can suppress the hypoxic drive to breathe, leading
to carbon dioxide retention and respiratory acidosis, which manifests as confusion and drowsiness. The
nurse must first assess the oxygen saturation to determine if the client is hypoxic or hypercapnic before
intervening. Increasing oxygen (A) could worsen CO2 retention. Notifying the RN (B) is important but
assessment precedes notification. Coughing and deep breathing (D) is not the priority when altered
mental status is present.
Question 3: A practical nurse is preparing to administer enoxaparin subcutaneously to a client with
deep vein thrombosis. Which technique is appropriate for this administration?
,A. Massage the injection site after administration
B. Expel the air bubble from the prefilled syringe
C. Inject at a 90-degree angle into the abdominal area
D. Aspirate before injecting to check for blood return
CORRECT ANSWER: C. Inject at a 90-degree angle into the abdominal area
RATIONALE: Enoxaparin, a low-molecular-weight heparin, should be administered subcutaneously at a
90-degree angle into the abdominal area (at least 2 inches from the umbilicus) to ensure proper
absorption and minimize tissue trauma. Massaging the site (A) increases the risk of hematoma
formation. The air bubble in prefilled enoxaparin syringes should not be expelled (B) as it helps clear the
needle track and prevent medication leakage. Aspiration (D) is not recommended for subcutaneous
anticoagulant injections as it can cause tissue trauma and bruising.
Question 4: A client who is 24 hours postoperative from a total hip arthroplasty is prescribed
enoxaparin for thromboprophylaxis. Which finding should the practical nurse report to the registered
nurse before administering the next dose?
A. Small bruise at the previous injection site
B. Platelet count of 90,000/mm³
C. Mild pain at the surgical site
D. Hemoglobin level of 12 g/dL
CORRECT ANSWER: B. Platelet count of 90,000/mm³
RATIONALE: A platelet count of 90,000/mm³ indicates thrombocytopenia, which is a significant
concern when administering anticoagulants like enoxaparin. This finding raises suspicion for heparin-
induced thrombocytopenia (HIT), a potentially life-threatening complication that requires immediate
evaluation and discontinuation of the medication. A small bruise (A) is an expected side effect of
subcutaneous anticoagulant administration. Mild surgical pain (C) and a hemoglobin of 12 g/dL (D) are
within expected postoperative parameters and do not contraindicate enoxaparin administration.
Question 5: A practical nurse is caring for a client with a new diagnosis of type 2 diabetes mellitus. The
client asks why lifestyle modifications are emphasized before starting medication. Which response by
the nurse is most appropriate?
A. "Medications for diabetes have too many side effects to start right away."
B. "Lifestyle changes can sometimes control blood glucose without the need for medications."
C. "Insurance companies require proof of lifestyle attempts before covering diabetes medications."
D. "Starting with medications first makes lifestyle changes less effective later."
CORRECT ANSWER: B. "Lifestyle changes can sometimes control blood glucose without the need for
medications."
RATIONALE: For many clients with newly diagnosed type 2 diabetes, evidence-based guidelines
recommend initiating medical nutrition therapy, physical activity, and weight management as first-line
treatment because these interventions can effectively lower blood glucose levels and may delay or
eliminate the need for pharmacologic therapy. Option A is inaccurate and may cause unnecessary fear.
,Option C is not a universally valid clinical RATIONALE. Option D is not supported by evidence;
medications and lifestyle changes are often used concurrently when needed.
Question 6: A client with hypertension is prescribed lisinopril. Which instruction should the practical
nurse include in the client's education?
A. "Take this medication with a high-potassium meal to enhance its effectiveness."
B. "Report a persistent dry cough to your healthcare provider."
C. "Increase your fluid intake to at least 3 liters per day while on this medication."
D. "Stop taking this medication if you experience dizziness."
CORRECT ANSWER: B. "Report a persistent dry cough to your healthcare provider."
RATIONALE: A persistent, dry, nonproductive cough is a well-documented side effect of ACE inhibitors
like lisinopril, occurring in up to 20% of clients. While not dangerous, it can significantly affect quality of
life and may require switching to an alternative antihypertensive class. Option A is incorrect; while ACE
inhibitors can cause hyperkalemia, clients should not intentionally increase potassium intake without
medical supervision. Option C is not specifically indicated for lisinopril and could be harmful in clients
with heart or kidney disease. Option D is dangerous advice; clients should never stop antihypertensive
medications abruptly without consulting their provider.
Question 7: A practical nurse is assessing a client with suspected appendicitis. Which finding is most
indicative of this condition?
A. Pain that begins in the epigastric area and migrates to the right lower quadrant
B. Generalized abdominal cramping relieved by defecation
C. Left lower quadrant tenderness with rebound
D. Epigastric pain that radiates to the back
CORRECT ANSWER: A. Pain that begins in the epigastric area and migrates to the right lower quadrant
RATIONALE: Classic appendicitis presents with visceral pain that starts as vague, crampy epigastric or
periumbilical discomfort, then migrates and localizes to the right lower quadrant (McBurney's point) as
inflammation involves the parietal peritoneum. This migration pattern is highly suggestive of
appendicitis. Option B describes symptoms more consistent with irritable bowel syndrome. Option C
suggests diverticulitis or other left-sided pathology. Option D is characteristic of pancreatitis or peptic
ulcer disease.
Question 8: A client is receiving continuous enteral feedings via a nasogastric tube. The practical nurse
notes the residual volume is 250 mL. Which action should the nurse take?
A. Hold the feeding and notify the registered nurse
B. Return the residual to the stomach and continue the feeding
C. Discard the residual and flush the tube with water
D. Increase the feeding rate to compensate for the residual
CORRECT ANSWER: A. Hold the feeding and notify the registered nurse
, RATIONALE: Gastric residual volumes (GRV) greater than 200-250 mL (depending on facility protocol)
may indicate delayed gastric emptying and increase the risk of aspiration. Holding the feeding and
notifying the RN allows for further assessment and potential intervention per protocol. Returning large
residuals (B) can contribute to gastric distention and aspiration risk. Discarding residuals (C) can lead to
electrolyte imbalances and is not standard practice. Increasing the feeding rate (D) would worsen gastric
distention and is contraindicated.
Question 9: A practical nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates the system is functioning properly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with respiration
C. Drainage of 100 mL of bright red blood per hour
D. The suction control chamber is set to 20 cm H₂O
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber with respiration
RATIONALE: Tidaling (fluctuation) of the fluid level in the water-seal chamber with inspiration and
expiration indicates that the chest tube is patent and the system is functioning correctly, reflecting
normal pressure changes in the pleural space. Continuous bubbling in the water-seal chamber (A)
indicates an air leak in the system. Drainage of 100 mL/hr of bright red blood (C) suggests active
hemorrhage and requires immediate notification. The suction control chamber setting (D) is a
prescribed parameter, not an indicator of proper function.
Question 10: A client with chronic kidney disease is prescribed sevelamer. The practical nurse
understands this medication is primarily used to:
A. Lower serum potassium levels
B. Bind dietary phosphate in the gastrointestinal tract
C. Stimulate erythropoietin production
D. Reduce systemic inflammation
CORRECT ANSWER: B. Bind dietary phosphate in the gastrointestinal tract
RATIONALE: Sevelamer is a phosphate binder prescribed for clients with chronic kidney disease to
prevent hyperphosphatemia. It works by binding dietary phosphate in the GI tract, preventing its
absorption and thereby reducing serum phosphate levels, which helps prevent secondary
hyperparathyroidism and renal osteodystrophy. Sevelamer does not lower potassium (A), stimulate
erythropoietin (C—this is the role of erythropoiesis-stimulating agents), or primarily reduce
inflammation (D).
Question 11: A practical nurse is preparing to administer a blood transfusion to a client. Which action
is the priority immediately before starting the transfusion?
A. Verify the blood product with another licensed nurse
B. Prime the IV tubing with normal saline
C. Obtain baseline vital signs
D. Ensure the client has signed the consent form
Study Guide 2025 Edition | Detailed Notes,
Key Concepts, Case Studies,
Pharmacology, Pathophysiology,
Nursing Procedures, Exam Preparation
Tips, Practice Questions, and Verified
Answers for Nursing Students and
Professionals
Question 1: A practical nurse is caring for a client with heart failure who is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate notification of the registered nurse?
A. Blood pressure 110/70 mm Hg
B. Urine output 30 mL/hr
C. Potassium level 3.2 mEq/L
D. Weight loss of 1 kg in 24 hours
CORRECT ANSWER: C. Potassium level 3.2 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes potassium excretion, placing the client at high
risk for hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L) and can
cause life-threatening cardiac dysrhythmias, muscle weakness, and fatigue. This finding requires
immediate notification for potential potassium replacement. Options A, B, and D represent expected or
stable findings in a client receiving diuretic therapy for heart failure.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The practical nurse notes the client is becoming increasingly confused and drowsy.
Which action should the nurse take first?
A. Increase oxygen flow to 4 L/min
B. Notify the registered nurse immediately
C. Check the client's oxygen saturation level
D. Encourage the client to cough and deep breathe
CORRECT ANSWER: C. Check the client's oxygen saturation level
RATIONALE: In clients with COPD, excessive oxygen can suppress the hypoxic drive to breathe, leading
to carbon dioxide retention and respiratory acidosis, which manifests as confusion and drowsiness. The
nurse must first assess the oxygen saturation to determine if the client is hypoxic or hypercapnic before
intervening. Increasing oxygen (A) could worsen CO2 retention. Notifying the RN (B) is important but
assessment precedes notification. Coughing and deep breathing (D) is not the priority when altered
mental status is present.
Question 3: A practical nurse is preparing to administer enoxaparin subcutaneously to a client with
deep vein thrombosis. Which technique is appropriate for this administration?
,A. Massage the injection site after administration
B. Expel the air bubble from the prefilled syringe
C. Inject at a 90-degree angle into the abdominal area
D. Aspirate before injecting to check for blood return
CORRECT ANSWER: C. Inject at a 90-degree angle into the abdominal area
RATIONALE: Enoxaparin, a low-molecular-weight heparin, should be administered subcutaneously at a
90-degree angle into the abdominal area (at least 2 inches from the umbilicus) to ensure proper
absorption and minimize tissue trauma. Massaging the site (A) increases the risk of hematoma
formation. The air bubble in prefilled enoxaparin syringes should not be expelled (B) as it helps clear the
needle track and prevent medication leakage. Aspiration (D) is not recommended for subcutaneous
anticoagulant injections as it can cause tissue trauma and bruising.
Question 4: A client who is 24 hours postoperative from a total hip arthroplasty is prescribed
enoxaparin for thromboprophylaxis. Which finding should the practical nurse report to the registered
nurse before administering the next dose?
A. Small bruise at the previous injection site
B. Platelet count of 90,000/mm³
C. Mild pain at the surgical site
D. Hemoglobin level of 12 g/dL
CORRECT ANSWER: B. Platelet count of 90,000/mm³
RATIONALE: A platelet count of 90,000/mm³ indicates thrombocytopenia, which is a significant
concern when administering anticoagulants like enoxaparin. This finding raises suspicion for heparin-
induced thrombocytopenia (HIT), a potentially life-threatening complication that requires immediate
evaluation and discontinuation of the medication. A small bruise (A) is an expected side effect of
subcutaneous anticoagulant administration. Mild surgical pain (C) and a hemoglobin of 12 g/dL (D) are
within expected postoperative parameters and do not contraindicate enoxaparin administration.
Question 5: A practical nurse is caring for a client with a new diagnosis of type 2 diabetes mellitus. The
client asks why lifestyle modifications are emphasized before starting medication. Which response by
the nurse is most appropriate?
A. "Medications for diabetes have too many side effects to start right away."
B. "Lifestyle changes can sometimes control blood glucose without the need for medications."
C. "Insurance companies require proof of lifestyle attempts before covering diabetes medications."
D. "Starting with medications first makes lifestyle changes less effective later."
CORRECT ANSWER: B. "Lifestyle changes can sometimes control blood glucose without the need for
medications."
RATIONALE: For many clients with newly diagnosed type 2 diabetes, evidence-based guidelines
recommend initiating medical nutrition therapy, physical activity, and weight management as first-line
treatment because these interventions can effectively lower blood glucose levels and may delay or
eliminate the need for pharmacologic therapy. Option A is inaccurate and may cause unnecessary fear.
,Option C is not a universally valid clinical RATIONALE. Option D is not supported by evidence;
medications and lifestyle changes are often used concurrently when needed.
Question 6: A client with hypertension is prescribed lisinopril. Which instruction should the practical
nurse include in the client's education?
A. "Take this medication with a high-potassium meal to enhance its effectiveness."
B. "Report a persistent dry cough to your healthcare provider."
C. "Increase your fluid intake to at least 3 liters per day while on this medication."
D. "Stop taking this medication if you experience dizziness."
CORRECT ANSWER: B. "Report a persistent dry cough to your healthcare provider."
RATIONALE: A persistent, dry, nonproductive cough is a well-documented side effect of ACE inhibitors
like lisinopril, occurring in up to 20% of clients. While not dangerous, it can significantly affect quality of
life and may require switching to an alternative antihypertensive class. Option A is incorrect; while ACE
inhibitors can cause hyperkalemia, clients should not intentionally increase potassium intake without
medical supervision. Option C is not specifically indicated for lisinopril and could be harmful in clients
with heart or kidney disease. Option D is dangerous advice; clients should never stop antihypertensive
medications abruptly without consulting their provider.
Question 7: A practical nurse is assessing a client with suspected appendicitis. Which finding is most
indicative of this condition?
A. Pain that begins in the epigastric area and migrates to the right lower quadrant
B. Generalized abdominal cramping relieved by defecation
C. Left lower quadrant tenderness with rebound
D. Epigastric pain that radiates to the back
CORRECT ANSWER: A. Pain that begins in the epigastric area and migrates to the right lower quadrant
RATIONALE: Classic appendicitis presents with visceral pain that starts as vague, crampy epigastric or
periumbilical discomfort, then migrates and localizes to the right lower quadrant (McBurney's point) as
inflammation involves the parietal peritoneum. This migration pattern is highly suggestive of
appendicitis. Option B describes symptoms more consistent with irritable bowel syndrome. Option C
suggests diverticulitis or other left-sided pathology. Option D is characteristic of pancreatitis or peptic
ulcer disease.
Question 8: A client is receiving continuous enteral feedings via a nasogastric tube. The practical nurse
notes the residual volume is 250 mL. Which action should the nurse take?
A. Hold the feeding and notify the registered nurse
B. Return the residual to the stomach and continue the feeding
C. Discard the residual and flush the tube with water
D. Increase the feeding rate to compensate for the residual
CORRECT ANSWER: A. Hold the feeding and notify the registered nurse
, RATIONALE: Gastric residual volumes (GRV) greater than 200-250 mL (depending on facility protocol)
may indicate delayed gastric emptying and increase the risk of aspiration. Holding the feeding and
notifying the RN allows for further assessment and potential intervention per protocol. Returning large
residuals (B) can contribute to gastric distention and aspiration risk. Discarding residuals (C) can lead to
electrolyte imbalances and is not standard practice. Increasing the feeding rate (D) would worsen gastric
distention and is contraindicated.
Question 9: A practical nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates the system is functioning properly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with respiration
C. Drainage of 100 mL of bright red blood per hour
D. The suction control chamber is set to 20 cm H₂O
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber with respiration
RATIONALE: Tidaling (fluctuation) of the fluid level in the water-seal chamber with inspiration and
expiration indicates that the chest tube is patent and the system is functioning correctly, reflecting
normal pressure changes in the pleural space. Continuous bubbling in the water-seal chamber (A)
indicates an air leak in the system. Drainage of 100 mL/hr of bright red blood (C) suggests active
hemorrhage and requires immediate notification. The suction control chamber setting (D) is a
prescribed parameter, not an indicator of proper function.
Question 10: A client with chronic kidney disease is prescribed sevelamer. The practical nurse
understands this medication is primarily used to:
A. Lower serum potassium levels
B. Bind dietary phosphate in the gastrointestinal tract
C. Stimulate erythropoietin production
D. Reduce systemic inflammation
CORRECT ANSWER: B. Bind dietary phosphate in the gastrointestinal tract
RATIONALE: Sevelamer is a phosphate binder prescribed for clients with chronic kidney disease to
prevent hyperphosphatemia. It works by binding dietary phosphate in the GI tract, preventing its
absorption and thereby reducing serum phosphate levels, which helps prevent secondary
hyperparathyroidism and renal osteodystrophy. Sevelamer does not lower potassium (A), stimulate
erythropoietin (C—this is the role of erythropoiesis-stimulating agents), or primarily reduce
inflammation (D).
Question 11: A practical nurse is preparing to administer a blood transfusion to a client. Which action
is the priority immediately before starting the transfusion?
A. Verify the blood product with another licensed nurse
B. Prime the IV tubing with normal saline
C. Obtain baseline vital signs
D. Ensure the client has signed the consent form
